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Сравнительное изучение гистологических изменений после применения различных способов облучения

назад в раздел Злокачественные опухоли

 

В связи с отсутствием сведений в периодической печати о постлучевых морфологических изменениях в саркомах мягких тканей мы поставили перед собой задачу провести сравнительное изучение гистологических изменений после применения различных способов облучения. Для выполнения поставленной задачи нами был использован материал Казахского научно-исследовательского института онкологии и радиологии на 62 больных, подвергавшихся лучевому лечению до операционного вмешательства на первичном очаге.

После уменьшения послелучевых реакций в промежутке от 2 до 3 недель были произведены соответствующие оперативные вмешательства. Гистологическая обработка операционного материала проводилась обычным способом с применением окраски гематоксилинозином, а также по Ван Гизону.

Наибольшую группу составляли фибросаркомы — 18 наблюдений. У 14 больных через 4—6 недель после применения дистанционной гамма-терапии в дозе от 3000 до 6000 рад новообразования становились плотными, имели четкие границы с окружающими тканями, волокнистую структуру и серо-розовый цвет. В окружающей клетчатке были старые кровоизлияния коричневого цвета.

Микроскопически новообразования сохраняли пучковое расположение волокон с образованием множества завихрений. Но обращало на себя внимание преобладание стромальной ткани над клеточным компонентом опухоли. Соединительнотканные тяжи на одних участках были представлены тонкими разрыхленными волокнами, на других — гомогенизированными толстыми пучками. Опухолевые клетки в основной своей массе находились в состоянии пикноза или набухания.

На отдельных участках встречались небольшие группы клеток с «нормальным строением» ядра, но без четких очертаний границ цитоплазмы. Эти клетки часто приобретали вид «голоядерных клеток».

В окружающей ткани нами были отмечены отек, кровоизлияния, очаговый фиброз и дегенерация мышц. Дегенерация в мышцах выражалась потерей исчерченности, гомогенизацией, пролиферацией ядер. В отдельных мышечных волокнах наблюдался ценкеропский некроз.

Капилляры опухоли и окружающей ее ткани характеризовались неравномерным полнокровием, периваскулярным отеком. В стенках сосудов мелкого и среднего калибра нередко наблюдался фибриноидный некроз. Крупные сосуды утолщены, эндотелий набухший. Реактивно-воспалительные изменениях как в опухолевой, так и в окружающей ее ткани выражались наличием фиброза и круглоклеточной инфильтрации.

Через 6 педель после облучения в дозе 7000 рад отмечалось усиление процессов коллагенизации стромальных элементов новообразования.

Миксосаркомы после облучения в 3000—5000 рад макроскопически сохраняли узловатое строение и без четких границ переходили в окружающую ткань. Одни узлы имели плотную консистенцию и волокнистое строение, другие напоминали «рыбье мясо» с миксоматозными участками.

 

 

 


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